Needle instrument for extracting biopsy sections

ABSTRACT

SPECIMEN TISSUE DRAWN BY SUCTION INTO A SPECIALLY FORMED SIDE PORT ADJACENT THE HOLLOW PENETRATING NEEDLE TIP IS SEVERED BY FORWARD MOTION OF A TUBULAR CUTTER SLIDABLE IN THE NEEDLE PASSAGE THROUGH PREHENSILE APPLICATION OF THUMB PRESSURE ON THE OUTER END OF AN ACTUATOR ROD. SUCTION IS APPLIED TO THE NEEDLE PASSAGE BEHIND THE CUTTER AND REACHES THE PORT THROUGH PASSAGE IN THE CUTTER ITSELF SO AS TO HELP RETAIN THE SPECIMEN IN THE CUTTER CUP. THE CUTTER IS REMOVABLE TO FACILITATE DISLODGING OF THE SPECIMEN AND TO SHARPEN AND CLEAN THE CUTTER.

p 21, 1971 H. "B. Ki-t tLoss, JR 3,505,873

NEEDLE INSTRUMENT FOR EXTRACTING BIOPSY SECTIONS Filed Oct. 4, 1968Mada/r02 //dn A,?D A. (611445.56

8 M W n Mu United States Patent 3,606,878 NEEDLE INSTRUMENT FOREXTRACTING BIOPSY SECTIONS Howard B. Kellogg, Jr., 3843 92nd NE.,Bellevue, Wash. 98004 Filed Oct. 4, 1968, Ser. No. 765,161 Int. Cl.A611) /00 US. Cl. 128-2B 2 Claims ABSTRACT OF THE DISCLOSURE Specimentissue drawn by suction into a specially formed side port adjacent thehollow penetrating needle tip is severed by forward motion of a tubularcutter slidable in the needle passage through prehensile application ofthumb pressure on the outer end of an actuator rod. Suction is appliedto the needle passage behind the cutter and reaches the port throughpassage in the cutter itself so as to help retain the specimen in thecutter cup. The cutter is removable to facilitate dislodging of thespecimen and to sharpen and clean the cutter.

DESCRIPTION This invention relates to improvements in surgicalinstruments for extracting biopsy sections and more particularlyconcerns a trocar or needle instrument of this nature which may be usedfor the nonincisional penetration of intervening tissues so as to reachinternal organs, membranes and tissues requiring examination. Theinvention is herein illustratively described by reference to thepresently preferred embodiment; however, it will be recognized thatcertain modifications and changes therein with respect to details may bemade without departing from the essential features involved.

A principal application for this invention is to provide an improvedinstrument with which to extract biopsy specimens from any of variousparts and regions otherwise ditlicult to examine nonoperatively,examples being lung tissue, pericardial tissues and peritoneal tissues.With this invention exploratory examination of dilferent regions of apatients lung, chest cavity liner, heart sac or other internal organsand membranes may be achieved quickly and without major trauma or shockto the patient and with reliable results flowing from the positionalprecision and controllability of the instrument for taking the specimen.The instrument is relatively simple in construction and easily operatedby a physician with a minimum of attendant equipment or help. Theinstrument is broadly intended for use both in clinical officeexaminations and in operating room procedures and is generallycompatible to all conventional auxiliary requirements for surgical instruments such as ease of cleaning and sterilization, producability in aform which is safely and reliably useable and similar qualities.

An object of this invention therefore is to devise an instrument of thedescribed nature which facilitates early safe examination of patients inbody cavity regions otherwise difficult to reach for biopsy studies byconventional techniques and instruments. A related object is to devisean instrument which is relatively versatile in that it may be used forextracting biopsy sections in any of various parts of the body and inparticular of doing so in the critical and diificult areas within thechest cavity which "ice are areas in which early and detailed knowledgeof conditions are most essential to proper and timely diagnosis of avariety of diseases and disorders.

In accordance with this invention an elongated bluntly-pointed hollowneedle instrument has a main passage extending lengthwise therein andopening near the tip of the instrument through a side wall or port intowhich a knuckle or bulge of tissue may be drawn by suction applied tothe opposite end of the passage when the port is pressed against thetissue surface. A cutter plunger preferably of cylindrical form slidablyreceived in the passage is operated by an actuator rod extendingslidably through the sealed opposite end of the passage. The cuttingedge is the forward edge of the cutter. Suction applied to the needlepassage behind the cutter is communicated through the cutter to theneedle passage forward of the cutter. Thus a specimen of indrawn tissuesevered by the cutter on its forward traversal of the side port in theneedle is received and held in the cutter interior. The suction helpshold the specimen reliably within the cup or cavity of the cutter forsubsequent removal after the needle is withdrawn from the patient.

These and other features, objects and advantages of the invention willbecome more fully evident from the following description thereof byreference to the accompanying drawings.

FIG. 1 is an isometric view of the improved instrument.

FIG. 2 is an enlarged isometric view of the cutter and adjacent endportion of the control rod which actuates the cutter, with theseelements separated for purposes of illustration.

FIG. 3 is a side view of the instrument appearing in FIG. 1.

FIG. 4 is an enlarged longitudinal sectional view of the instrument fromthe aspect shown in FIG. 3, with the plunger retracted.

FIG. 5 is a view similar to FIG. 4 with the plunger thrust forward tosever a biopsy specimen.

Referring to the drawings, the instrument resembles a trocar-typeinstrument, which in this case comprises an elongated tubular stylet orhollow needle body 10 having a bluntly-pointed tip 12. The body 10comprises a straight tube the longitudinal bore of passage in which 10aextends throughout its length and is closed at its forward or distal endby the tip fitting 12' exteriorly bluntly pointed and of round crosssection. The tip fitting has a base 12a plugged into the end of theneedle body. At location A near the rearward or proximal end of theneedle it is provided with a short branch or elbow comprising tube 14extending at an angle to the tube 10. The branch section 14 has an endfitting 14a for connecting it to a suction hose 16 or syringe shown inbro-ken lines. Beyond the branch 14 the main tube 10 terminates in aninternally threaded coupling head 10" into which a plug 18 is threadedtightly so as to compress a gasket 20 against a seat in the base of thehead 10. The plug 18 has a knurled ring 18a by which it may be tightenedand removed through application of finger pressure. The plug iscentrally aperturedso as to pass a slide rod 22. Leakage of air past therod is prevented by lateral expansion of the seal 20 under pressure fromtightening of the plug 18. Rod 22 is connected to a hollow cylindricalcutter knife 24 slidably received in the central passage of the tube 10.This knife is of tubular form and has a sharp cutting tip 24a formed bybeveling its distal end outwardly from its inner to its outer peripheralsurface. At its inner or proximal end the cutter 24 is internallythreaded to receive a connector fitting 26 which is welded or otherwisesecured at 28 to the actuation rod 22. The connector fitting 26 has acentral passage 26a. leading into the interior of cutter 24 andbranching passages 2612 leading to the exterior of the fitting, whichitself has an external diameter slightly smaller than the passagediameter of needle tube 10. As a result, the hollow interior of cutter24 hence the needle tube passage ahead of the cutter are in directcommunication through the passages 26a and 26b with the passage a behindthe cutter, hence with the section branch 14.

Near its tip 12 the tubular needle body 10 has a side aperture or port10b which may be traversed longitudinally by the cutting edge 24athrough advancement of the actuator rod 22. The length of the cutter 24somewhat exceeds the length of the aperture 10b, so that with the cutterin its forwardmost position as shown in FIG. 5, the cutter closes offthe aperture 10b. This forwardmost position of the cutter is establishedby contact between the base of the thumbstall 30 on the end of rod 22and the outer face of the plug fitting 18, in which position the cuttingedge 24a stops just short of contact with the fitting 12 forming the tipor point of the trocar. In this manner the cutting edge is protectedagainst dulling contact with a metallic surface. Port 10b is preferablyformed as the intersection of the tubular form of needle body 10 withthe convex side of another cylinder transverse to it, which cuttercylinder side has a progressively decreasing radius in the directionfrom the base to the tip end of needle 10.

It will also be seen that various handle arrangements may be providedwith the instrument, that shown being similar to a conventional trocarhandle in which the body portion is provided with two fingerstalls 32and 34 on opposite sides thereof near the base or proximal end of theinstrument. Thus the surgeon may conveniently hold the instrument byplacing two fingers in the respective stalls 32 and 34 and his thumb inthe thumbstall 30.

In use suction is applied through the hose 16 or syringe to the branch14 and thereby to the internal passages within the tubular body 10 ofthe instrument. This suction extends through the passages 26a and 26b tothe interior of the cutter 24 and from there to the port or aperture10b. When the instrument is to be inserted for taking a biopsy specimen,such as in the chest cavity for example, the surgeon typically makes avery short incision in the skin of the patient and then punches theinstrument through the fascia and muscle. With the fascia and musclepenetrated, the surgeon then tilts and revolves the instrument, withappropriate awareness and control of the relative position of theaperture 10b,to the region sought, until the aperture is pressed againstthe pleura surface of the chest cavity, against the lung, or the heartsac, depending upon the material to be excerpted. With the cutter 24then retracted, the applied suction draws a knuckle or bunch of thetissue T into the entrance of the port 10b and thereby into the path ofthe cutter 24. At this point the bulge of tissue drawn by suction intothe instrument appears as in FIG. 4. The surgeon then applies forwardthrust to the cutter through advancement of the rod 22' so as to advancethe cutter to the position shown in FIG. 5 and in so doing shears offthe knuckle of tissue. The described shape of the aperture as an anvilor reaction edge for the tissue during cutting helps gather the materialinto a shape during increase of cutting pressure from the blade in whichpulling and tearing will be minimized, and at the same time closes offthe aperture 1012 against further application of suction to the tissuesurface T and against loss of the cut specimen in subsequentlyretracting the instrument. Preferably suction continues to be appliedduring withdrawal so that the severed specimen of tissue held within.the cup of cutter 24 will be reliably retained even though accidentallythe cutter might be retracted and the port partially reopened.

When the instrument is withdrawn from the patient the surgeon unscrewsthe plug fitting 18 and withdraws the cutter out of the open base end ofthe needle instrument whereby the specimen of tissue may be removed fromthe cutter cup for examination purposes. Should it not drop out of thecutter cup readily, the cup may be unscrewed from the fitting 26 inorder to press the specimen out of the cutter.

In its various applications to biopsy specimen removal the instrument isin each instance intended to perforate intervening body tissues with aminimum of injury and laceration of adjoining tissues. It may be appliedto pericardial examinations, peritoneal examinations and various others.Only the tissue surface from which the biopsy section is taken isaffected by the instrument during the process of penetration andremoval. A clean cut is made in the removal process so as to avoidlaceration and tearing of adjoining tissues. The facility with which theinstrument may be disassembled for cleaning, for specimen removal, andfor sharpening of the cutter if necessary are further advantages.

Unlike prior suction type invention instruments for specimen removal,the prehensile grip and actuation arrangement of the present instrumentcomprising fingerstalls and thumbstall, and the forward direction ofmotion of the cutter on its cutting stroke effected by closing movementof the thumbstall toward the fingerstalls is an important featurefacilitating holding of the instrument and applying maximum force to thecutter with steadiness during the cutting stroke. This is particularlyimportant in the cutting of tough tissues or in cases wherein delicatelyprecise positioning of the inserted instrument are critical.

These and other aspects of the invention will be evident to thoseskilled in the art based on an understanding of the foregoing disclosureof the preferred embodiment thereof.

What is claimed is:

1. A biopsy specimen-taking trocar instrument for use by puncturing itinto the human chest cavity and similar applications, comprising anelongated hollow needle of rigid tubular form pointed at one endadapting it to pierce through hard chest cage tissues and having alongitudinal passage therein terminating at the point, the pointed endbeing of symmetrically round cross section tapering smoothly from thetubular exterior on a longitudinal convex curvature which decreases inradius toward the tip extremity to a smoothly rounded tip adapted toslide over soft internal tissues without lacerating them, said needlehaving a side opening closely adjacent the point so as to admit aknuckle of specimen tissue into the passage, said opening being formedsubstantially as the intersection of the needles exterior with acylindrical surface at right angles to the needle, a cutter received insaid passage for longitudinal movement and having a forward cutting edgetransversely contoured to the passage wall in a sliding fit therewithadapting it to sever the admitted tissue by traversing said openingtoward the point, handle means fixedly mounted on the needle back fromthe pointed end including finger stalls on opposite sides of the needlein predetermined positional relationship to the side opening, meanscomprising a fitting connected with the needle back from the pointed endthereof at a location for applying suction to the needle passage behindthe cutter in a position of the cutter retracted behind said opening,said cutter comprising means forming a passage for communicating theapplied suction past the cutter and to said passage forwardly of thecutter, actuator means connected with the cutter and extendingexteriorly of the needle to permit manually moving the cutterlongitudinally in said passage, said cutter comprising a tubular memherhaving a sharpened forward cutting edge surrounding a tissue-receivingreceptacle in the path of communication of suction applied from behindthe cutter, said actuator means comprising a longitudinally extendingrod having a thumbstall on the exterior end thereof, a removable closurefitting on the end of the needle opposite the point through which therod passes slidably, means forming a seal closing the needle passageagainst entry of air around the rod, and a fitting on the interior endof the rod, said fitting and said tubular cutter member being detachablyinterconnected.

2. The instrument defined in claim 1 wherein the side opening is formedas the intersection of the needle exterior with another cylinder withprogressively decreasing radius in the direction forward of the needle.

References Cited UNITED STATES PATENTS 737,293 8/1903 Summerfeldt 1283052,708,437 5/ 1955 Hutchins 1282UX 3,033,194 5/1962 Lippert 12823,173,414 3/1965 Guillant 1282 5/1966 Ashizawa et al 1282UX 12/1966Dwyer et al. 1282 10/1968 Springer 1282 5/1926 Muir 1282 FOREIGN PATENTS11/1965 Belgium 1282 3/1958 France 1282 11/1961 Germany 1282 6/1968Great Britain 1282 8/1962 U.S.S.R. 1282 10/1966- U.S.S.R. 1282 US. Cl.X.R.

